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Biomedical subjects

L Räf

Publications and source records attributed to L Räf.

At least 19 recordsLinked to original sources
PubMed2001

[High number of bile duct injuries in cholecystectomy. There is a connection with the use of the laparoscopic technique].

During the 1990s 152 cases with injuries of the bile ducts in connection with cholecystectomy in 81% performed via laparoscopic technique were reported to the Swedish Patients' Insurance Company. In 116 cases there was a lesion of the common duct, in 24 cases there was a defect in the duct. A peroperative cholangiogram was carried out in more than two thirds of the cases. Lesions of the common duct could in most cases be repaired with suture and drainage. In 44 cases, however, a Roux anastomosis to the small intestine had to be performed. To prevent bile duct injuries during cholecystectomy, the anatomy of the operative field must be clarified before tubular structures are divided. Peroperative cholangiography as routine during cholecystectomy is recommended.

Adolescent↗
PubMed2001

[Complications in laparoscopy--what can we learn by experiences?].

Complications after laparoscopic procedures in gynecological and surgical clinics were discussed at a symposium held in Stockholm in September of 2000. According to official and professional records the number of laparoscopic operations has increased, especially in surgical clinics. Although this technique entails many advantages for patients, it is accompanied by an increase in the number of complications, some of which are not seen in open surgery. About ten injuries to vessels in the abdominal wall or the abdominal cavity, leading to major bleeding, occur yearly in the course of insertion of laparoscopic instruments. In about the same number of cases the intestines are perforated. Many gynecological procedures are performed using laparoscopic technique, for instance 90% of sterilizations. In operations of the adnexa, the most common complications are related to introduction procedures. At hysterectomy, complication frequency is not higher in laparoscopic operations than when open or vaginal methods are used. About 70% of cholecystectomies in Sweden are performed laparoscopically. The total number of complications is not higher than in open surgery, but the number of injuries to the common and hepatic ducts is higher after laparoscopic cholecystectomy. The importance of perioperative cholangiogram to prevent such injuries is stressed.

Cholecystectomy, Laparoscopic↗
PubMed2000

[Review of claims from the Patient Insurance: spinal anesthesia is not completely without risks].

The Patient Injury Claims Department in Sweden grants compensation to patients who have incurred injury in the national health service system. All claims involving spinal and epidural anaesthesia were studied during the period 1997-1999. Serious neurological complications were behind 29 out of 65 claims. These occurred more frequently after epidural anaesthesia (1:4,000) than after spinal anaesthesia (1:13,000) with the exclusion of obstetric epidural anaesthesia (1:40,000). Epidural haematoma occurred in 1:30,000 after epidural anaesthesia, in 1:200,000 after spinal anaesthesia. One epidural abscess occurred in 60,000 epidural anaesthesias, while five cases of meningitis occurred after spinal anaesthesia (1:40,000).

Analgesia, Epidural↗
PubMed2000

[Nerve damage after thyroid-parathyroid surgery. Recurrent nerve paralysis significantly impair quality of life in many patients].

Forty-seven cases of permanent vocal cord paralysis after neck surgery are investigated. Very few operations were described as technically problematical. The recurrent laryngeal nerve was identified in 77% of the procedures. Patients in particular need of an excellent voice in their work or leisure activities described a definite decrease in quality of life after surgery. Straightforward information concerning this complication should always be given to the patient preoperatively.

Adult↗
PubMed2000

[Malpractice in connection with radius fractures must be reduced. Clear guidelines for treatment and follow-up are required].

PSR handles the vast majority of malpractice injuries in Sweden. PSR is a claims handling company which settles claims for malpractice on behalf of the insurance company owned by the Swedish county councils: the County Councils Mutual Insurance Company. A central issue in the law regulating patient injuries in Swedish health care is to define injuries that could have been avoided if a certain therapeutic/diagnostic procedure or a more appropriate method had been utilized. PSR arranged a multiprofessional conference regarding guidelines to decrease the number of malpractice injuries in the treatment of distal radius fractures. Among the most important issues defined were: To improve and standardize diagnostic imaging Patient information Early decision making in surgery and physical/occupational therapy A more well-defined indication for surgery, in which type of trauma, biological age and functional demands are considered in addition to radiographs Less stereotyped thinking in follow-up Controlled randomized trials.

Clinical Competence↗
PubMed1999

[Spinal manipulation--treatment associated with a high risk of complications].

The article consists in a review of injuries for which claims were submitted to one or another of three insurance companies during a two-year period, and which had arisen in conjunction with manipulation of the cervical spine (n = 21), thoracic spine (n = 6), lumbar spine (n = 13), or the sacro-iliac joint (n = 14). Cervical spine manipulation had caused injury of the vertebral artery with resulting paralysis in three cases, and cervical disc herniation in three cases. Lumbar spine manipulation had caused disc herniation in six patients, of whom three had severe persistent problems. Of the 14 patients who had undergone manipulation of the sacroiliac joint, six had disc herniation which was operated with varying outcome. One patient with a compression fracture of an osteoporotic L3 vertebra developed paraparesis.

Adult↗
PubMed1999

[How to avoid injuries in connection with surgery? Perioperative nerve injuries are probably underreported].

The occurrence of mechanical nerve injury in connection with anaesthesia and surgery is probably more common than generally believed, and by no means all cases are reported to the patient injury claims department. Both incorrect positioning of the patient on the operating table and pressure from retractors and other instruments can contribute to the occurrence of such injuries. Both neurological and neurophysiological procedures should be used to localise the injury, particularly for the purpose of insurance assessment. Most important of all, however, is prevention of injury. Risk minimisation is dependent on the observation of meticulous routines in surgery units, and clear division of staff responsibilities. The surgical injury rate can be monitored by means of a register of general complications.

Humans↗
PubMed1997

[Missed appendicitis a timebomb. Greater number of physicians are reported to the Health Services Disciplinary Board today than 50 years ago].

In its early stages appendicitis often manifests itself by uncharacteristic symptoms, which may result in delayed diagnosis and treatment. A greater number of physicians are reported to the Health Services Disciplinary Board (HSDB) for missed appendicitis today than formerly, and disciplinary measures are more severe. This is shown by a unique breakdown of reported cases for three periods between 1945 and 1997.

Appendicitis↗